Mental Illness – 40% of Malaysians are at risk

Mental Illness – 40% of Malaysians are at risk

This is as genuine as any reality could be. Malaysia is in the watch list of countries with a rising number of mental health patients. According to the psychological experts, Malaysians will face some form of mental health issues during the course of their lives.

Mental health no longer a minor problem

The numbers are adding up. 4 out of 10 Malaysians will have this problem and if nothing is done in the near future, that number will continue to increase. A specialist from a renowned medical university stated that the number has been downplayed because of how people perceive mental health.

What do we mean mental illness?

The stigma that goes with mental health or illness is that a person is perceived to be ‘crazy’ or ‘insane’. Such negativity does not help in any way. In fact, it could mean a lot more other issues like:

  1. schizophrenia
  2. bipolar disorder
  3. depression
  4. and many others

The idea here is that such conditions must be accepted and acknowledge. Otherwise, there is no way to treat them. Among the many conditions, depression is perhaps one of the most alarming. According to a report by The World Bank, by the year 2020, it is predicted that there could be more than 340 million people in the world that could suffer from depression.

Could happen to anyone

There is no denying that mental health conditions are blind and it does not only happen to the weak, lonely or poor. A person who looks happy and jovial could well be having depression issues in his private time. A good example of this is the late Hollywood celebrity Robin Williams who has for much of his career been associated with happy and family-oriented roles.
In a recent survey by the National Health and Morbidity, only about 1.8% of the population in Malaysia have depression but the experts believe otherwise and that it could at least be 10 times more.

The main problem here is that Asians do not like to talk about their issues or problems they are facing. As such, many are suffering in silence. Caucasians on the other hand has no qualms about visiting a psychiatrist. Asians believe that talking about their problems is a form of weakness.
As such, it is almost impossible to know if someone is having this problem by the outlook. Meanwhile, depression is known to be the most disabling disease, according to the National Institute of Health unlike conditions like stroke or diabetes where a patient can get out of.

Are there successful treatments?

Like any other form of conditions, the first step is to acknowledge that there is a problem. Then the patient can be treated. Help and support are always at hand. With all that, patients can be restored and lead their normal lives again. Having said that, societal acceptance and empathy would be crucial as well so that the patients can break away from the stigma and the label of being ‘different’.

Are you abused?

Abuse is not just about being beaten up. It can be physical, sexual, emotional or verbal. Neglect — when parents or caregivers do not take care of the basic needs of the people who depend on them — is also a form of abuse.

Physical abuse is often the most easily spotted form of abuse. It may be any kind of hitting, shaking, burning, pinching, biting, choking, throwing, beating, and other actions that cause physical injury, leave marks, or cause physical pain.

Sexual abuse is being forced into any type of sexual activity that you do not agree to, such as inappropriate touching, sexual intercourse, rape and molest.

Emotional abuse can be difficult to pin down because there may not be physical signs. Emotional abuse happens when yelling and anger go too far or when parents constantly criticize or threaten you to the extent that your self-esteem and feelings of self-worth are damaged. Emotional abuse can hurt and cause damage just as physical abuse does.

Neglect is probably the hardest type of abuse to define. Neglect occurs when a child or young person does not have adequate food, housing, clothes, medical care, or supervision. Emotional neglect happens when a parent doesn’t provide enough emotional support or deliberately and consistently pays very little or no attention to a child.

Often, abuse happens within the home. It can happen in any family. Sometimes parents abuse each other, which can be hard for a child to witness. Some parents abuse their children by using physical or verbal cruelty as a way of discipline.

Abuse can also take place outside the home. Bullying is a form of abusive behavior. Bullying someone through intimidation, threats, or humiliation can be just as abusive as beating someone up. People who bully others may have been abused themselves.

Abuse can also take the form of hate crimes directed at people just because of their race, religion, abilities, gender, or sexual orientation.

Recognising abuse

Strange as it may sound, but some people don’t realise that they are being abused. They have lived with it for so long – they think that is just the way things are and nothing can be done. And, some people blame themselves for being abused – they think they are bad or have done something wrong, and therefore deserve to be abused.

There are people from families where there is violence or abuse, and they don’t know that there are other ways for family members to treat each other. A person who has only known an abusive relationship may mistakenly think that hitting, beating, pushing, shoving, or angry name-calling are perfectly normal ways to treat someone when they are in a foul mood. Children from families where their parents treat each other abusively may think that it is normal for husbands and wives to treat each other that way.

BUT ABUSE IS NOT NORMAL! You should not let anyone abuse you – not your parents, your classmates, your boyfriend – not anybody at all.

Signs of being abused

  • Problems going to sleep, staying asleep or sleeping more than usual
  • Difficulties with short-term memory, concentration and problem solving
  • Pessimistic outlook on life, feeling cynical and distrusting others
  • Strong emotions including sadness, anger, anxiety and guilt
  • Depression and feelings of hopelessness
  • Increased tendencies to self-harm or suicidal behavior
  • Loss of interest in life, school, friends and hobbies

Abusers may threaten their victims by saying things like: “If you ever tell anybody, I’ll hurt you and your family” or ” No one will believe you and you’ll go to jail for lying.” This is the abusers’ way of frightening their victims into keeping silent about their abuse.

On the other hand, victims of abuse may not get help because it means they are betraying someone they love — especially when the person treats them well most of the time and are abusive only some of the time. For example, if the father who is the breadwinner in the family has been sexually abusing his daughter, reporting him means he will go to jail and they will lose their source of income. For these reasons, abuse often goes unreported.

If you or anyone you know is being abused, talk to someone you trust – whether it is a family member, a teacher, counsellor or your family doctor. Getting help and support is an important step towards changing the situation.

Do you have a drinking problem?

It is one thing to have the occasional drink to chill out with your friends. But it becomes a problem if you crave for it and cannot control your drinking.

Alcohol addiction or alcoholism is defined as a strong need for an intoxicating liquid which includes beer, wine, and other hard liquors. If the person experiences withdrawal symptoms such as nausea, sweating, shakiness, or anxiety when he stops drinking or need to drink greater amounts of alcohol in order to feel a high, the person is most likely alcoholic.

More young people are experiencing the consequences of drinking too much, at too early an age. Research shows that people tend to drink the heaviest in their late teens and early to mid-twenties.

Young adults are especially likely to binge drink and to drink heavily.

Binge drinking

Binge drinking refers to the heavy consumption of alcohol over a short period of time (ie., within a session of drinking such as visit to pub)- just as binge eating means a specific period of uncontrolled over-eating. Many young people start to drink from peer pressure.

Other reasons for drinking include:

  • Curiosity – they want to know what it is like to drink alcohol.
  • To feel good – they believe that it will make them feel good, not realising it could just as easily make them sick and hung-over.
  • To reduce stress – they may look at alcohol as a way to reduce stress, even though it can end up creating more stress.
  • To feel more mature.
  • To socialise better.

Effects of binge-drinking Excessive drinking can lead to difficulty concentrating, memory lapses, mood changes, and other problems that affect your day-to-day life. Binge drinking carries more serious and more long-lasting effects such as:

Alcohol Poisoning: Alcohol poisoning is the most life-threatening consequence of binge drinking. When someone drinks too much and gets alcohol poisoning, it affects the body’s involuntary reflexes — including breathing and the gag reflex. If the gag reflex is not working properly, a person can choke to death on his vomit.

Other signs of alcohol poisoning include:

  • extreme confusion
  • inability to be awakened
  • vomiting
  • seizures
  • slow or irregular breathing
  • low body temperature
  • bluish or pale skin

Impaired Judgment: Binge drinking impairs judgment, so drinkers are more likely to take risks they might not take when they are sober. And if they are driving, they may cause accidents injuring themselves and other road users. Or, they have unprotected sex, putting them at risk of sexually transmitted diseases or unplanned pregnancy.

Physical Health : Studies show that people who binge-drink during their adolescence are more likely to be overweight and have high blood pressure by the time they are 24. Just one can beer contains about 150 calories, which adds up if he drinks four or five cans of beer a night.

Mental Health: Binge drinkers have a harder time in school and they are more likely to drop out. Drinking affects their sleep, which can make it harder to stay awake and concentrate during the day resulting in poor academic performance.

Those who binge-drink may find their friends drifting away because alcohol affects their personality, often making them behave obnoxiously.

Alcohol Abuse

Alcohol abuse is drinking to the extent that it affects your responsibilities at home, at work or in school. It also affects your relationship with other people. Excessive drinking also impairs your judgement, making it dangerous for you to drive. There are those whose drinking affects their relationship with other people including their spouse. For youths, the impact of drinking is much more damaging given that their body is not fully developed to metabolise alcohol. They are also more prone to brain damage and other medical problems.

Alcohol abuse does not involve physical dependence on alcohol. But if it is not treated, alcohol abuse can lead to alcohol dependence.

Alcohol dependence

Alcohol dependence is what we often refer to as alcoholism. Alcoholics are addicted to alcohol and do not have control over their drinking. They develop a tolerance to alcohol and experience withdrawal symptoms when trying to stop.

Alcohol is a depressant drug. In small amounts, it can induce a pleasing effect. However, being a depressant, it can eventually cause the person to feel down and depressed.

Cirrhosis of the liver is one of the most common effects of alcohol abuse. Cirrhosis stops the liver from being able to remove toxins from the body. Alcohol abuse can also cause stomach ulcers that lead to internal bleeding.

Sensible Drinking

If you choose to drink – do so within limits. Follow these guidelines for low risk drinking:

  • Men should limit alcohol use to two standard drinks per day
  • Women should not consume more than one standard drink per day
  • Pregnant women should abstain from alcohol completely, as it could adversely affect the development of the child

Getting high on drugs

Not everyone who uses drugs becomes addicted. But, for many what starts as casual use leads to drug addiction. Drug addiction is a dependence on a street drug or a medication.. Youths become addicted to drugs through self-medication and experimentation.

Drug addiction can cause serious, long-term consequences including problems with physical and mental health, relationships, employment and the law. Once hooked on drugs, it is difficult to quit. Most people need professional help to kick their drug habit.

here are three main types of drugs that are frequently abused, and lead to addiction – prescription and non-prescription drugs, also known as street drugs. Currently, the most popular substance of choice is inhalants.


Inhalants include a range of products – many of which are familiar household items – which, when vaporized and inhaled, may cause the user to feel intoxicated or “high”. They are considered to be “gateway” drugs because children often progress from inhalants to illegal drug and alcohol abuse

Types of inhalant are solvents such as contact cement, glue, nail polish, aerosols such as hairsprays, spray paints, insecticides, muscle sprays), and anesthetics which are frequently used in dentistry for sedative effects. Inhalants are abused through the following ways:

Sniffing – inhaling vapors directly into the nose from an open container.

Huffing – inhaling vapors directly into the nose from a cloth soaked with the solvent which is held against the face.

Bagging – holding a paper or plastic bag filled with the solvent which is then held over the face.

Consequences of inhalant abuse can be fatal such as suffocation and accidents relating to inhalant intoxication and unintentional suicide.

Warning signs to look out for inhalant abuse:

  • Finding unusual amounts of glues, solvents or aerosol containers in your friend’s bag
  • Chemical smells or stains on clothes or breath
  • Unexpected and rapid “drunken” behaviour; look drowsy
  • Looking pale or in a dazed state
  • Constant sniffles or nose irritations
  • Mood swings – feeling depressed or easily irritable
  • Truancy; poor conduct in class; isolation
  • Slurred or incoherent speech
  • Nausea or loss of appetite

Prescription Drugs

Prescription drugs are obtained through a prescription from a doctor. Most people get addicted to these three types of prescription drugs.

  • Opiate-based medications such as morphine or codeine, prescribed for pain relief or cough suppression.
  • Sedatives or tranquilisers which sedate and promote sleep or what is known as sleeping pills Drugs like Dormicum are commonly prescribed tranquilisers.
  • Stimulants like Ritalin or certain slimming pills which are used to treat Attention Deficit Disorder.

Non-prescription drugs / Illegal drugs

Heroin, ketamine, cannabis (marijuana), ecstasy and amphetamines are examples of illegal or street drugs. There are serious penalties for possessing and consuming illegal drugs in Singapore, which range from fines and imprisonment up to 10 years, or the death penalty for trafficking.

The people who are addicted to drugs will not admit that they have a problem. It is up to you as a family member or friend to step in and get him the help he needs.

Here are some warning signs to look out for drug addiction:

  • Unsteady gait and incoordination
  • Preoccupation with finding and consuming drugs
  • Constant excuses for continuing to use, despite promise to quit
  • Concealing drug-taking behaviour, afraid of being discovered
  • Frequent job changes and always in debt
  • Prone to health problems due to lack of sleep and skipping meals
  • Frequent accidents and falls
  • Feeling exhausted, depressed or suicidal
  • Wearing long sleeved shirts all the time or at inappropriate times (to conceal intravenous drug abuse)

Recognising alcohol dependence

Drinking is a problem if it causes trouble in your relationships, school and social activities, or affects how you think and feel.

Ask yourself the following questions to find out if you have a problem with alcohol. You may have a drinking problem if you answer “yes” to any of the questions.

  1. Do you sometimes drink more than you mean to?
  2. Have you tried to cut back on your drinking and failed?
  3. Have you blacked-out (have trouble remembering things that happened) while drinking?
  4. Has your drinking made your problems at school, work or with relationships go from bad to worse?
  5. Do you keep drinking even though you know it’s causing problems?
  6. Do you drink when you feel stressed?
  7. Do you drink alone?
  8. Are you able to drink more now than you used to be able to?
  9. Do you ever feel uncomfortable when you haven’t had a drink?
  10. Do you drink even when it’s important to stay sober?

If you think you or someone you know have a drinking problem, get help as soon as possible. The best approach is to talk to an adult you trust — if you can’t approach your parents, talk to your doctor, school counsellor or a relative.

People do recover from alcohol dependence. Recovery begins with the desire to change and by accepting the right support. Honesty, openness, willingness and consistency are key factors in recovery. Seeking help for alcohol problems is definitely not a sign of weakness.The earlier you seek treatment the better your chances of dealing with the problem.

Taking a gamble

From young, they see their parents and other adults gambling. Then, when they are older with more pocket money, they may get together with their friends for a game of cards – some even with their parents’ approval. It may seem harmless at first because the stakes are small. But the seed of gambling has been planted in them.

Problem gambling was never thought of as a youth issue. Today, with the growing availability of gambling opportunities and the social acceptance of gambling as a safe, harmless diversion, young people are becoming addicted to gambling. As with adults, youth gambling addiction can negatively impact every aspect of life, from learning and school performance, to mental and physical health.

It can also lead to criminal and other anti-social behaviour, and other addictions.

Signs to look out for in gambling addiction:

  • Unexplained need for money
  • Money or possessions missing from the home
  • Unexplained charges on credit card bills
  • Withdrawal from friends and family
  • Missing school or classes
  • Frequent anxiety, depression or mood swings
  • Dropping of outside activities and interests
  • Late night calls
  • Sudden drops in grades
  • Interest in sports teams with no previous allegiance
  • Suspicious behaviour on computer
  • Displays of unexplained wealth
  • Insomnia
  • Thefts and gambling-related offences such as loan sharking and illegal bookmaking.

Suicidal Issue


– Choose Life!

Suicide cannot be undone. Life may be hard right now but whatever the difficulties you are facing at the moment, will pass. And the life ahead of you – it cannot be all bad, there will be good times and think of the good things that you are passing up on if you decide to end it all now.

You don’t have to go through your difficulties alone. Let your family or friends help you. Or, speak to your school’s counsellor or your family doctor who will be able to get you the help you need.

Suicide is among the top three causes of death among young people aged 15 to 35 years old. For every completed suicide, there would be about 15 attempted suicides. More than half of those who committed suicide had made previous attempts. One in 10 who attempted will try again within one year or commit suicide at a later stage.

While more women attempt suicide than men, more men commit suicide than women. The reasons for suicide range from relationship or family problems, to academic stress, financial difficulties and marital problems.

Suicidal behaviour

Suicidal behaviour includes completed suicide, attempted suicide and thoughts about suicide.

Reasons for suicidal behaviour include:

  • A recent loss or break-up of a close relationship
  • An unhappy change in circumstance at work, school, or home life
  • A painful and/or disabling physical or mental illness
  • Some degree of dependency on alcohol or drugs
  • A history of suicide in the family
  • Traumatic experiences such as physical and/or sexual abuse
  • Unwanted pregnancy
  • Alienation & rejection by peers and/family
  • Financial problems

Look out for warning signals in the people around you – your family, friends and colleagues. And heed their cries for help.


  • Drastic change in appetite
  • Drastic change in sleep patterns
  • Drastic change in weight
  • Fatigue or lethargy
  • Drastic change in physical appearance
  • Lack of interest in appearance
  • Poor health


  • Persistent depressed mood
  • Unstable emotions
  • Easily agitated & frustrated
  • Feelings of worthlessness
  • Feelings of hopelessness & helplessness
  • Difficulties in concentration & decision-making
  • Anxious & tense
  • Unrealistic expectations of self


  • Social withdrawal
  • Drastic change in attitude & character
  • Giving away prized possessions
  • Self-harm behaviors
  • Noticeable increase in compulsive behaviors
  • Unexplained cries
  • Substance abuse
  • Direct or indirect suicidal threats

Talking openly to someone about suicide does not make it more likely to happen. Suicide occurs because there is pain and a belief that no one can help, and that there is no other way out of the pain except death. Talking about it allows the pain to decrease, which provides hope and a chance for life to get better.

If someone you know is contemplating suicide, take the initiative and ask him directly, “Are you thinking about killing or harming yourself?” and “How are you going to kill yourself?” This will give him a chance to open up to you. You are not betraying him if you then decide to speak to another person – an adult, teacher, counsellor or his parents. You are doing so because you fear for his safety.

MYTHS about Suicide

Myth #1: People who threaten suicide are just seeking attention.
Truth: Suicide threats are warning signs of someone in desperate need of help. Suicide attempts must be treated seriously.

Myth #2: People who talk about suicide will not really do it.
Truth: 80 per cent of completed suicides have prior warning signs.

Myth #3: Suicide is an impulsive act
Truth: While suicide can be an impulsive act, many completed suicides are well-planned.

Myth #4: Anyone who tries to kill himself must be crazy.
Truth: Extreme distress and emotional pain are not signs of mental illness.

Myth #5: If a person has thoughts to kill himself, nothing can stop him.
Truth: Most are ambivalent about dying and hope to be rescued.

Myth #6: Talking about suicide may give someone the idea.
Truth: Suicide occurs because there is pain and a belief that no one can help, and that there is no other way out of the pain except death. Talking about it allows the pain to decrease, which provides hope and a chance for life to get better.

Myth #7: The only effective intervention for suicide comes from the professional psychotherapist.
Truth: Anyone can help provide emotional support and encouragement.

Myth #8: Improvement after crisis means the suicidal risk is over.
Truth: Most repeated suicidal attempts occur within three months after signs of recovery are observed.

If you are feeling suicidal now, call 999. Stay on the phone with them until someone comes to you. Or, you may call Samaritans of Singapore at 1800 221 4444 anytime day and night.



Deliberately Injuring Yourself

Some people turn to hurting themselves physically as a way of dealing with their overwhelming anger, tension or frustration. This is known as self-harm, self-injury, self-mutilation or self-abuse.

For these people, hurting themselves brings about a momentary sense of calm and a release of tension. And then it is usually followed by guilt and shame and the return of painful emotions that drove them to it. Self-harm is often done on impulse and may be associated with other conditions such as depression.

Self-harm – What are the symptoms?

Self-harm symptoms include:

  • Cutting
  • Burning,
  • Picking or interfering with wound healing,
  • Infecting oneself,
  • Punching/hitting self or objects,
  • Inserting objects in to skin,
  • Bruising or breaking bones, and
  • Some forms of hair pulling.

To cover up their scars, these people may turn to wearing long pants and long-sleeved shirts.

Self-harm may also take less obvious forms, such as:

  • Taking unnecessary risks
  • Staying in an abusive relationship
  • Developing eating problems (anorexia, bulimia)
  • Abusing alcohol or drugs

Most people who engage in self-injury are adolescents. Self-injury often starts in the early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness and conflicts with parents or other authority figures.

The majority of the people who self-injure are females, even though the percentage of young men seems to be on the rise.

Help is available

Research shows that those who seek professional help and therapy have a good chance of recovery.

Some tips to stop self-harm:

  • Keep notes of what is going on when
  • you feel the need to harm yourself so that
  • you can identify, over a period of time,
  • specific thoughts which come up
  • Try to talk about your feelings with someone supportive and whom you can trust.
  • Work on building your self-esteem. You are not to be blamed for how you feel; self-injury is an expression of powerful negative feelings.
  • Try to find ways to make your life less stressful by
    – Eating healthily
    – Getting plenty of sleep
    – Exercising to keep fit
  • Have the telephone number of friends, or help lines ready at hand so that you can call and talk to someone instead of hurting yourself.

Family, friends and teachers can help by looking out for people around them who may be resorting to self-harm and referring them to get professional treatment.

Warning signs to look out for include irritability, poor sleeping and eating habits and withdrawal from society.

Please talk to someone,

  • If you are concerned whether someone you know may have self-harm behavior
  • If you are concerned that you may have self-harm behavior

Why do people self-harm?

Those who self-harm usually experience:

  • Emptiness
  • Inability to understand or express feelings
  • Loneliness
  • Fear
  • Past abuse
  • Depression

They often feel helpless or powerless with regard to their emotions. They are more likely to have low self-esteem, depressed or anxious.

Thus, inflicting pain to oneself may serve a number of purposes:

  • A way of getting painful emotions out
  • Of being distracted from the painful emotions
  • Communicating feelings to somebody else
  • Finding comfort
  • Self-punishment
  • Attempt to gain control over life

Self-harm is NOT about attempting suicide. It is a way to cope with or relieve painful or hard-to-express feelings.

Sleeping Disorder


Good Night, Sleep Tight

If only we sleep like a baby every night! Truth is, for most of us, there are nights when we toss and turn, and have difficulty falling asleep. Or, we sleep badly during the night and then wake up in the morning feeling anything but rested.

Not sleeping well for a few days leaves us feeling tired and lethargic. And if this continues for too long, it can affect your concentration in school or at work. In time, it can affect your health too.

There many types of sleep disorders. The more common ones are:

  • Difficulty falling asleep
  • Difficulty sleeping through the night
  • Feeling sleepy during the day
  • Sleeping too much
  • Excessive snoring
  • Frequent nightmares
  • Sleeping walking



Out of touch with reality

Psychosis is a serious but treatable medical condition caused by a disturbance in the brain.

People with psychosis are out of touch with reality. It affects their way of thinking, believing, perceiving and/or behaving. For people experiencing psychosis, the condition can be very disorienting and distressing. Without effective treatment, psychosis can overwhelm their lives and that of their families.

Psychosis is more likely to occur in young adults, affecting about three in 100 persons. Studies indicate that response to treatment and chances of recovery improve with early intervention and treatment.

Some possible factors contributing to psychosis are:

  • Physical illness
  • Environmental factors
  • Genetic predisposition


Early intervention and treatment will lead to a better and faster recovery. It may also
prevent increasing severity of the illness and in some cases, suicide. There are new and more effective medications, as well as improved treatment programmes which contribute to better outcome for people with psychosis.

Besides medication, counseling, psychotherapy and practical assistance such as getting help with school or work are other important aspects of treatment.

Eating Disorder


Obsession with food and weight

We have all at one time or another looked into the mirror and then tell ourselves that we need to lose some weight. Those who are more disciplined may lose one or two kg. But for most of us, we try half-heartedly to watch what we eat, and then give up after a few days – so what if we are a little overweight!

But, there are some people who are obsessed about their body image and become preoccupied with food and weight to the point that it affects them physically and psychologically. For these people, it has become an eating disorder which can cause serious health problems and even death. Although, eating disorders are more common in females, it can also happen to males, and usually starts during adolescence or early adult life.

There are specific “indicators” a young person with eating disorder may display. Some indicators are more difficult to identify as recognizing them requires a certain level of interpretive skills and often emerge only in therapy. However, an understanding of the indicators is helpful for friends and caregivers to understand the day-to-day challenges faced by young people with eating disorders. While friends and caregivers should not assume the role of diagnosing a young person as having eating disorders, they are in an excellent position to observe and keep notes about warning signs and forward their concerns to the appropriate professionals.

Types of eating disorder

There are two types of eating disorders:

  • Anorexia Nervosa
  • Bulimia Nervosa

Anorexia nervosa
People suffering from anorexia nervosa are obsessed with food and being thin, sometimes to the point of starving themselves to death.

There are two sub-types of anorexia nervosa:

  • Restricting type where they lose weight through dieting, fasting, or excessive exercise. They don’t regularly engage in binge-eating or purging.
  • Binge-eating/ purging type where they regularly engage in binge-eating and/or
    purging to lose weight or prevent putting on weight. Purging involves self-induced vomiting or the use of laxatives, diuretics, or enemas.

Bulimia nervosa
People with bulimia go through regular episodes of bingeing and purging. During these episodes, they eat a large amount of food in a short duration and then try to rid of the extra calories by self-induced vomiting, excessive exercise or the use of laxatives, diuretics, enemas or other medications.

There are two sub-types of bulimia nervosa:

  • Purging type where they regularly engaged in self-induced vomiting or use of laxatives,diuretics, or enemas.
  • Non-purging typewhere they attain weight loss through fasting or exercising excessively.

Bulimia Nervosa
Bulimia nervosa is characterized by:

  • Recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes.
  • Behaviour that compensates for overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviours. Due to feelings of disgust or shame, bulimic behavior is often done secretly.

There are two sub-types of bulimia nervosa:

  • Purging type where regularly engage in self-induced vomiting or use of laxatives, diuretics, or enemas.
  • Non-purging type where they attain weight loss through fasting or exercising excessively.

Indicators of Bulimia Nervosa

A young person with Bulimia Nervosa may exhibit some or many of the following indicators:
Eats a large amount of food over a short period of time
Engages in purging or inappropriate compensatory behaviours after eating, including self-induced vomiting, fasting, excessive exercise and/or the misuse of laxatives or diuretics
Eats in private or is secretive about eating behaviours
Often eats a restrictive diet
Prefers high-fat, high-carbohydrate and high-sugar “junk” foods during binge episodes
Frequently uses the bathroom for extended periods of time after eating
Engages in “acting out” behaviours, such as shoplifting, binge spending, alcohol or drug use and/or sexual promiscuity
Shows a marked decline in school attendance patterns
Often appears socially outgoing, but on close examination, relationships may tend to be superficial
Sets high goals and constantly strives for perfection
Often appears to be of average weight or overweight
Cognitive Indicators
Preoccupied with food. Conversations, school projects, artwork, etc. may revolve around food themes
Difficulty concentrating
Appears indecisive or conversely, exhibits rigid “black-and-white” thinking
Makes comments about being overweight or expresses a belief in the importance of self-control when it comes to eating habits
Expresses fears about intimacy in personal relationships
Affective Indicators
Appears anxious, depressed, angry, irritable, defiant, stubborn or displays intense mood sings
Expresses feelings of inadequacy, worthlessness, anxiety and loneliness
Demonstrates feelings of low self-esteem through appearance, attire, body language or social relations
Tends to be withdrawn and appears isolated
Expresses a fear of weight gain
Expresses feelings of failure with less than perfect school grades
Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic
Expresses fears about intimacy in personal relationships
Feels dependent on others for approval and appreciation, relying on others to determine self-worth


Physical Indicators
Exhibits broad fluctuations in weight
Experiences dental problems, broken blood vessels under the eyes, eyebags or throat problems. These are physical conditions that can be caused by self-induced vomiting
Complains of dehydration, fainting spells, dizziness, hand tremors or blurred vision
Suffers from ongoing stomach problems
Engages in binge eating, eating large quantities of food over short periods of time
Experiences loss or irregular menstrual periods
Engages in binge eating, eating large quantities of food over short periods of time

Postnatal Depression


Emotion Wellness During and After Pregnancy

There are few experiences in life that are as significant as that of being a mother. Having a baby can be an exhilarating and sometimes unpredictable time. Along with the physical changes of childbearing and giving birth, a woman may also go through emotional changes as she prepares for motherhood. Sometimes, instead of being excited, joyful and in the brink of good health, she can find herself struggling to cope with the pregnancy, or with caring and adapting to a newborn in her life.

A woman’s emotional well-being during this period of time is just as important as her physical health. During pregnancy, a woman under tremendous stress may go into early labour. After delivery, a mother who experiences symptoms of depression may have difficulty bonding with the child.

Studies have shown that up to one in 10 women would experience depression during pregnancy or after birth. If you are having the symptoms of depression or anxiety for most days up to two weeks, or you have difficulties functioning in your daily life, you are entitled to be cared for, so that you can go on to care for your loved ones.

Symptoms of depression include:

  • Low mood
  • Irritability
  • Tearfulness
  • Poor sleep
  • Loss of interest or pleasure in activities
  • Poor appetite
  • Poor concentration or forgetfulness
  • Loss of energy
  • Excessive self-blame or guilt
  • Feeling hopeless or that life is meaningless.

Some women may also have accompanying anxiety symptoms, such as:

  • Feeling tense
  • Palpitations, feeling breathless, chest tightness
  • Panic attacks
  • Excessive worries about the baby.

Depression is highly treatable if you are willing to seek help. Treatment involves therapy or counseling, and medication where necessary. Women often worry about the safety of antidepressants, but there are options available for pregnant or lactating women that are clinically beneficial.


Getting into a routine
If dealing with your pregnancy or coping with a newborn gets too overwhelming for you, establishing a routine will help you feel better in control of your life. If you are caring for your new born, try working your activities and schedule around the baby as he needs your care. Also, do allow flexibility to changes in your schedule, as an infant’s feeding and sleeping patterns may change over time.

Taking care of yourself
Taking care of yourself means allowing you to have time for yourself to rest or to do little things that you enjoy. It will do you a world of good to be out of the house for a breather or fresh air, even for a short period of time. You may even want to go window shipping or to catch up with a friend.

Eating well and exercising
Taking care of yourself also means taking care of what you eat, so that you have the right nutrition needed to carry your baby, or to recover from childbirth. Exercise would help build up your immune systems and prepare you with the energy needed for your pregnancy and childbirth. Please consult your obstetrician for advice if you are not sure of what is appropriate for you.

Talking to someone
Finding your husband or friend, a doctor or counselor to talk about your thoughts and feelings is also a great way of releasing your pent-up emotions. You should be able to get your emotional support from your husband, but someone with symptoms of depression and anxiety should benefit form seeking advice and treatment from a specialist.

Writing your thoughts down
Another way to keep your days going is to write your thoughts and feelings down in a diary. Having a baby is a life-changing and significant time for you. Writing down your thoughts could help you to keep track and gain a better perspective of what happened and how things have affected you.

Getting people to help
Coping with pregnancy or a newborn can be an enormous stress for many people. Do not be embarrassed about getting the help that you need, may it be with household chores or with caring for your baby or older child. You would need to rest and conserve your energy for you and your baby.

KKH will be conducting active screening for antenatal and postnatal depression in selected clinics, and we hope that this will enable us to identify early those suffering form emotional disorders, so that care and support may be provided early. Insert Map of KKH with details on how to get there



More Than Just The Blues

All of us have days when we feel “low” or “blue.” But when you are feeling low to the point that it affects your ability to work and to carry on with your daily life, and if it goes on for more than two weeks, then you may be suffering from depression.

Some facts about depression:
About 121 million people suffer from depression worldwide.

  • Between 20 per cent and 50 per cent of children and teens struggling with depression have a family history of this struggle and the children of depressed parents are more than three times as likely to suffer from depression.
  • Depression often co-occurs with anxiety disorders and substance abuse, with 30 per cent of teens with depression also experience a substance abuse problem. Among the people who suffer from depression, two-thirds of them never seek treatment.

If left untreated, depression is the number one cause of suicide.

Difference between sad and depressed

It is part and parcel of life to have things happen which get us upset and feeling down. This may be a relationship problem, problems in school or at work. This sadness is normal if it is short-lived and resolves without any treatment.

Depression on the other hand is an illness, a medical condition like diabetes or cancer. Depression is not a flaw in your personality and neither is it something that you can simply “snap-out” of.

When you are depressed, you will have difficulty coping at home and at work. You find yourself withdrawing from your family and friends, and you are not in the mood to do.

Typical symptoms of Depression

Depression affects each person differently. The first step is to recognise the symptoms of depression.

Symptoms include:

  • Depressed mood (persistent sadness, anxious or “empty” feelings)
  • Decreased ability to manage one’s emotions
    – Feelings of hopelessness
    – Feelings of anger and irritability
    – Feelings of guilt, worthlessness and/ or helplessness
  • Loss of interest and motivation in activities or hobbies once deemed pleasurable
  • Increased fatigue and lack of energy
  • Impaired thinking, e.g. poor concentration and attention
  • Change in sleep patterns, e.g. insomnia, early morning wakefulness, excessive sleeping
  • Change in appetite or weight
  • Persistent aches or pains, headaches, cramps or digestive problems
  • Having bleak and gloomy outlook, including thoughts of death or suicide

There is no shame to admit that you are suffering from depression.

If popping a few Panadols doesn’t help make your headache better after a few days, you go and see a doctor. In the same way, if you tried helping yourself to snap out of your low moods and it is not getting any better, you should get professional help.

Speak to someone close to you – like a family member or friend, or someone you trust – it may be your teacher or school counsellor. Sometimes, sharing your worries and thoughts with another person may help you feel better. But, if this doesn’t help, get professional help. If you don’t know where to turn to, see your family doctor and he will be able help you.

What causes depression?

There are many causes of depression. Most times, it is a build-up of stress from reacting to the things that are happening to you. If this goes on for too long, it causes a chemical imbalance in the brain causing depression.

Factors which can heighten the risk of developing depression under periods of stress include:

  • Multiple demands on one’s time without sufficient moments to relax
  • Certain personality characteristics such as being anxious or easily worried, lack of self-esteem and confidence, or excessive perfectionism
  • Fragile biochemistry, either due to genetic factors or as a result of viral infections, medical illness or recent childbirth
  • Drinking excessive alcohol or excessive use of illicit substances e.g. marijuana.

Types of depression

There are several different types of depression. They are distinguished by symptoms, duration and severity of symptoms. A common criterion is that their symptoms either cause significant distress, or impair your daily functioning.

Some of the types of depression include:

  • Major depression
  • Dysthymia
  • Depression in bipolar disorder
  • Psychotic depression

Major depression is when depressed feelings build up gradually over a period of time, like a few weeks. Young people often have mood swings and this makes it difficult to diagnose as depression because it may be mistaken as normal adolescent moods.

Dysthymia is a milder form of depression but it is often continuous and can last for longer periods ranging from months to years. People who have dysthymia may continue to go through their daily rituals; however, they would do so with decreased interest, motivation, confidence and pleasure. They usually have low self-esteem and may have difficulty concentrating and making decisions. Dysthymia also interferes with sleep, appetite and energy.

Bipolar or manic depression causes people to have severe high and low moods. People who have this illness switch from feeling overly happy and joyful to feeling very sad, and vice versa. Because of the highs and the lows—or two poles of mood—the condition is referred to as “bipolar” depression. In between episodes of mood swings, a person may experience normal moods.

Psychotic depression is characterised by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren’t there) or delusions (irrational thoughts and fears). This type of depression is more common with someone suffering from schizophrenia.

Depression and suicide
People suffering from depression are at risk of taking their own lives. Because of this, they need to get help urgently. It is important for all of us to be able to recognise the symptoms of depression so that if we notice them in our family members, friends and colleagues, we can step in and help them get professional help.

Treatment for depressions

Sometimes, all a person who is depressed needs is a listening ear and a shoulder to cry on. However, if this doesn’t help, seek professional treatment.

The good news is that depression is treatable. Like diabetes and other chronic diseases, depression may require long-term treatment. However, with timely intervention and treatment, the symptoms of depression will gradually go away.

Most people with depression feel better with a combination of medication, counselling and the support of family and friends.

Antidepressants are given to correct the chemical imbalance. Some of the common antidepressants include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). And they are not addictive.

In severe cases, the use of electroconvulsive therapy (ECT) may be used to treat depression.


anxiety singapore

Anxiety – what’s normal, what’s not

All of us experience feelings of anxiety from time to time. It is a feeling of uneasiness, nervousness, worry, fear or dread of what is about to happen or what may happen.

Picture this scenario:

You have your department’s regular meeting the next day for staff to update each other about their current projects. Just the thought of speaking in front of your colleagues is making you anxious. You can’t sleep the night before because of the anxiety building up in you.

Finally, the meeting is over. You feel a huge sense of relief and begin to relax. But the memory of the meeting is still playing in your mind. You are unsure if you had made a fool of yourself. Your week passed by quickly with no problems at work. In the following week, you received news that the boss will attend the regular meeting. And he is known for being critical, not one to mince his words. On the night before the meeting, you toss and turn in your bed as the thought of the meeting fills you with some anxiety.

It is normal to feel anxious when faced with new, unfamiliar or challenging situations such as going for an important meeting, a new date or make a presentation in front of an audience. You feel your heart pounding, your hands get sweaty or you feel the pit in your stomach. Although these situations don’t threaten your safety, they can cause you to feel “threatened” by potential failure or embarrassment. These are normal feelings of anxiety. In fact, some degree of anxiety pushes us to do our best.

Anxiety disorder

However, if you are often preoccupied with unrealistic or excessive fear and worry, and the intense feelings of anxiety overwhelm you and interfere with our daily life activities and performance, you may have an anxiety disorder.

Anxiety disorder can take on the form of

  • panic disorder,
  • phobia,
  • generalised anxiety disorder,
  • post-traumatic stress disorder and
  • obsessive-compulsive disorder.

Generalised Anxiety Disorder

People with generalised anxiety disorder (GAD) often worry excessively about things, even though there is little or nothing to provoke them. They anticipate disaster and are overly concerned about health issues, family problems, money, or difficulties at work.

Sometimes, just thinking about getting through the day produces anxiety.

A person is diagnosed as suffering from GAD if he worries excessively about everyday situations for at least six months. People with GAD cannot seem to get rid of their concerns even though they realise that their anxiety is more intense than the situation warrants.

Some of the common experiences encountered by people with GAD include:

  • difficulty relaxing,
  • startle easily,
  • poor concentration,
  • difficulties sleeping or sleeping too much,
  • fatigue or tiredness,
  • headaches,
  • muscle tension,
  • muscle aches,
  • difficulty swallowing,
  • trembling,
  • twitching,
  • feeling irritable,
  • sweating,
  • nausea,
  • dizzy,
  • having to go to the bathroom frequently,
  • feeling out of breath and
  • hot flushes.

If the anxiety level is mild, people with GAD can function socially and work. But when their anxiety is severe, they find themselves unable to carry out the simplest daily activities. They are paralysed with their fear and anxiety.

Generalised anxiety disorder affects twice as many women as men. The disorder develops gradually and can begin at any point in time, although the years of highest risk are between childhood and middle age. It is often accompanied by other anxiety disorders, depression or substance abuse.

Obsessive Compulsive Disorder

People with obsessive compulsive disorder (OCD) experience unwanted thoughts that seem to make no sense but nevertheless cause them to feel anxious. They may have irrational thoughts of contaminating themselves or others with dirt or germs, or they may be obsessed about their own safety or the safety of a loved one.

Because of these obsessive thoughts, they may carry out certain activities obsessively like washing their hands repeatedly or the need to do certain things in a particular pattern. It is not as if they enjoy carrying out these activities. At best, these rituals provide temporary relief from the anxiety created by their obsessive thoughts.

Other common obsessions include

  • frequent thoughts of violence and harming loved ones,
  • persistently thinking about performing sexual acts that the person dislikes, or
  • having thoughts that are forbidden by religious beliefs.

People with OCD may also be preoccupied with order and symmetry, have difficulty throwing away things, so they accumulate or hoard things which they don’t need.

While healthy people also have rituals, such as checking if the stove is off several times before leaving the house, the difference is that those with OCD perform their rituals even though doing so affects their daily life and they often find the repetition distressing. Most adults with OCD recognise that the rituals are senseless. In children and some adults, they may not realise that their behaviour is out of the ordinary.

Obsessive compulsive disorder can be accompanied by eating disorders, other anxiety disorders, or depression. It affects men and women in roughly equal numbers and usually appears in childhood, adolescence or early adulthood. One third of those with OCD develop symptoms as children, and research shows that OCD may run in families.

The course of OCD varies with individuals. Symptoms may come and go, ease over time, or get worse. When OCD becomes severe, the person may have difficulty working or carrying out normal responsibilities at home. They may sometimes try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety reaction that develops after a traumatic event that involved physical harm or the threat of physical harm, such as

  • a car accident,
  • rape,
  • abuse,
  • train wrecks,
  • plane crashes or
  • natural disasters such as floods or earthquakes.

People suffering from PTSD may have been harmed or witnessed harmful events that happened to loved ones or even strangers.

They may be easily frightened, become emotionally numb (especially in relation to people with whom they used to be close to), have irrational outbursts of anger and suffer from depression.

They may also avoid situations that remind them of the original incident, and often find it very difficult to cope during anniversaries of the incident.

Most people with PTSD also repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells or feelings, and are often triggered by ordinary occurrences, such as door slamming. A person experiencing a flashback may lose touch with reality and believe that the traumatic event is happening all over again.

Not every traumatised person develops full-blown PTSD. Symptoms usually begin within three months of the event but may occasionally emerge years afterward. They must last more than a month to be considered PTSD. Some people recover within six months, while others experience symptoms that last much longer. In some people, the condition stays with them for life. Post-traumatic stress disorder can happen at any age, including childhood. Women are more likely to develop PTSD than men. It is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Panic Disorder

Have you ever experienced such sensations like the following?

  • sweating,
  • nausea,
  • trembling,
  • numbness in the legs or hands,
  • dizziness,
  • hot or cold flashes,
  • a feeling of tightness or pressure in the chest,
  • hyperventilation,
  • “jelly” legs or
  • blurred vision,
  • felt like you were going to die of a heart attack or,
  • losing control of your body functions

It is likely that you were having a panic attack. And it is more common than you think. According to some reports, one out of three young adults has had a panic attack in the last year.

These intense feelings of panic usually do not last for very long and most people brush off the episode as “freaking out.” Some people become very agitated however, and develop a fear of it happening again.

If you have more than four panic attacks within a month or a panic attack occurs even when you are not in an anxious or stressful situation, it is probable that you have a panic disorder. People who are susceptible to panic attacks are more likely to be concerned with illness, death or losing control. Panic disorders usually happen to those between 20 and 30 years old.


A phobia is an irrational and uncontrollable fear of an object or a situation. It is unclear how phobias start, but if a person is prone to excessive anxiety and stress, he is more likely to be vulnerable to panic attacks and phobias.

People with phobias experience feelings of intense panic when confronted by whatever it is that frightens them and go to considerable lengths to avoid the object or situation.

There are different types of phobias:


Agoraphobia is fear of fear itself. People develop agoraphobia out of the fear of a panic attack occurring in a situation where help is unavailable or escape difficult. They associate places or feelings as the cause of their panic attacks so they try to avoid the place or situation.

Those suffering from agoraphobia become highly dependent. This can be exhausting and frustrating for family members and friends. They may confine themselves to their homes, worry excessively about their health, abuse alcohol or become suicidal. Agoraphobia is often associated with depression.

Social Phobia:

People with social phobia become overwhelmingly anxious and extremely self-conscious in everyday social situations. They have an intense, persistent and chronic fear of being watched and judged by other people and they fear doing things that will embarrass them.

The anxiety produced by a social phobia can be so intense that they find themselves

  • blushing,
  • stammering,
  • sweating,
  • experience stomach upsets,
  • racing heart,
  • trembling limbs or
  • experience a full-scale panic attack.

When these symptoms occur, people with social phobia often feel as though all eyes are on them. As a result, they may have difficulty starting a conversation, asking questions, making friends or joining groups, and their fear may become so severe that it interferes with work, school, and other normal daily activities.

While many people with social phobia realise that their fears about being with people are unreasonable or excessive, they find it difficult to overcome their fear. Even if they manage to confront their fears and be around with other people, they are usually anxious beforehand, feel intensely uncomfortable throughout the social situation, and after that worry about how they were judged by others.

Social phobia usually begins in childhood or early adolescence. Women and men are equally likely to develop this disorder. There is also some evidence this phobia may be genetic. Social phobia is often accompanied by other anxiety disorders or depression, and they may turn to substance abuse to manage their anxiety.

Specific Phobia: People with a specific phobia experience anxiety only when confronted with the thing they most fear. Some of the more common specific phobias are centered around

  • closed-in places,
  • heights,
  • escalators,
  • tunnels,
  • highway driving,
  • water,
  • flying,
  • rats,
  • cockroaches and,
  • blood.

Specific phobias are not just extreme fear; they are irrational fear of a particular thing. A person may be able to ski the world’s tallest mountains with ease but is unable to go above the fifth floor of a building. For these people with specific phobias, facing or even thinking about facing their feared or situation can bring on a panic attack or severe anxiety.

If the feared object or situation can be easily avoided, people with specific phobias may not seek help. However, if the avoidance interferes with their jobs or personal lives, specific phobias can become disabling and they may seek treatment for it.

Specific phobias usually appear in childhood or adolescence and tend to continue into adulthood. It is twice as common in women as men.

Help is available

Here is the good news – there has been much progress in the understanding and diagnosis of anxiety disorder. It is a common condition and is not a sign of weakness. And it can be treated effectively.

Cognitive behavioural therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalised anxiety disorder, among many other conditions.

Cognitive behavioural therapy addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

  • Cognitive therapy examines how negative thoughts contribute to anxiety.
  • Behaviour therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of cognitive behavioural therapy is that our thoughts – not external events – affect the way we feel. In other words, it is not the situation you are in that determines how you feel, but your perception of the situation.

The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel. You can also learn techniques like meditation to help you stay calm. Your doctor can prescribe anti-depressants to help ease your anxiety.

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” ~ Bill Clinton

A myriad of challenges await young people as they transit from adolescents to young adults. They face such challenges as academic pressures from higher levels of education, social pressures of starting a career, family or having to deal with illness or death of a loved one.

Because of this, young people may be vulnerable to the onset of major mental health problems. Studies show that one in five young people has a mental health disorder. Mental health problems can be treated and early intervention ensures good recovery. The first step is to recognise the warning signs and symptoms and get professional help.